The essential feature of sexual dysfunctions is inhibition in one or more of the phases including disturbance in the subjective sense of pleasure or desire or in the objective performance. Either type of disturbance can occur alone or in combination. They can be lifelong or acquired, generalized or situational, and may result from psychological factors, physiological factors, or combined factors.

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Sexual disorders can lead to or result from relational problems, and patients invariably develop an increasing fear of failure and self-consciousness about their sexual performance. Sexual dysfunctions are frequently associated with other mental disorders, such as depressive disorders, anxiety disorders and personality disorders. Sexual function can be adversely affected by stress of any kind, by emotional disorders, or by ignorance of sexual function and physiology. The dysfunction may be lifelong or acquired – that is, it can develop after a period of normal functioning. The dysfunction may be generalized or limited to a specific partner or a certain situation.

The essential feature of the sexual dysfunctions is inhibition in one or more of the phases, including disturbance in the subjective sense of pleasure or desire or in the objective performance. Either type of disturbance can occur alone or in combination. They can be lifelong or acquired, generalized or situational, and result from psychological factors, physiological factors, or combined factors. Sexual disorders can lead to or result from relational problems, and patients invariably develop an increasing fear of failure and self-consciousness about their sexual performance. Sexual dysfunctions are frequently associated with other mental disorders, such as depressive disorders, anxiety disorders and personality disorders etc. Sexual function can be adversely affected by stress of any kind, by emotional disorders, or by ignorance of sexual function and physiology. The dysfunction may be lifelong or acquired that is, it can develop after a period of normal functioning. The dysfunction may be generalized or limited to a specific partner or a certain situation.

Persistently or recurrently deficient (or absent) sexual fantasies and desire for sexual activity. The judgment of deficiency or absence is made by the clinician, taking into account factors that affect sexual functioning, such as age and the context of the person’s life.

Abstinence from sex for a prolonged period sometimes results in suppression of sexual impulses. Loss of desire may also be an expression of hostility to a partner or the sign of a deteriorating relationship. In one study of young married couples who ceased having sexual relations for 2 months, marital discord was the reason most frequently given for the cessation or inhibition of sexual activity.
Increased prolactin can also be a reason again which can be treated. Sexual desire commonly decreases after major illness or surgery, particularly when the body image is affected after such procedures as mastectomy, ileostomy, hysterectomy and prostatectomy. Illnesses that deplete a person’s energy, chronic conditions that require physical and psychological adaptation, and serious illnesses that can cause a person to become depressed can all markedly lessen sexual desire in both men and women. A recent study found markedly lower levels of serum testosterone in men complaining of low desire than in normal controls in a sleep-laboratory situation. Drugs that depress the central nervous system (CNS) or decrease testosterone production can decrease desire.

Persistent or recurrent extreme aversion to and avoidance of, all (or almost all) genital sexual contact with a sexual partner, characterized by an aversion to, and avoidance of, genital sexual contact with a sexual partner or by masturbation. Various previous bad experiences and underlying fear/ anxiety maybe responsible for such situation. They have to be assessed and treated accordingly.

The surface of the brain is involved in controlling both sexual impulses and processing of sexual stimuli that may lead to sexual activity. In studies of young men, some areas of the brain have been found to be more active during sexual stimulation than others.

Many neurotransmitters (chemicals in the brain: dopamine, epinephrine, norepinephrine, and serotonin) are produced in the brain and affect sexual function. For example, an increase in dopamine is presumed to increase libido. Serotonin, produced in the upper pons and midbrain, exerts an inhibitory effect on sexual function. Oxytocin is released with orgasm and is believed to reinforce pleasurable activities. Sexual arousal and climax are ultimately organized at the spinal level. Sensory stimuli related to sexual function are conveyed via various nerves like the pudendal, pelvic, and hypogastric nerves.

Testosterone increases libido in both men and women, although estrogen is a key factor in the lubrication involved in female arousal and may increase sensitivity in the woman to stimulation. Progesterone mildly depresses desire in men and women as do excessive prolactin and cortisol. Oxytocin is involved in pleasurable sensations during sex and is found in higher levels in men and women following orgasm.

Arousal is triggered by both psychological and physical stimuli; levels of tension are experienced both physiologically and emotionally; and, with orgasm, normally a subjective perception of a peak of physical reaction and release occurs. Psychosexual development, psychological attitudes towards sexuality, and attitudes towards one’s sexual partner are directly involved with, and affect, the physiology of human sexual response. Every normal human being has four-phase sexual response cycle.

Phase I: Desire
The classification of the desire (or appetitive) phase, which is distinct from any phase identified solely through physiology, reflects the psychiatric concern with motivation towards sexual activity. This phase is characterized by sexual fantasies and the desire to have sexual activity.

Phase II: Excitement
The excitement and arousal phase, brought on by psychological stimulation (fantasy or the presence of a love object) or physiological stimulation (stroking or kissing) or a combination of the two, consists of a subjective sense of pleasure. During this phase, penile tumescence leads to erection in men and vaginal lubrication occurs in women. Various other changes occur in different parts of the body. Voluntary contractions of large muscle groups occur, heartbeat and respiration rates increase, and blood pressure rises. Heightened excitement lasts from 30 seconds to several minutes.

Phase III: Orgasm
The orgasm phase consists of a peaking of sexual pleasure, with the release of sexual tension and the rhythmic contraction of the perineal muscles and the pelvic reproductive organs.
A subjective sense of ejaculatory inevitability triggers men’s orgasms. The forceful emission of semen follows. The male orgasm is also associated with four to five rhythmic spasms of the prostate, seminal vesicles, vas, and urethra. In women, orgasm is characterized by 3 to 15 involuntary contractions of the lower third of the vagina and by strong sustained contractions of the uterus, flowing from the fundus downward to the cervix. Both men and women have involuntary contractions of the internal and external anal sphincters. Other manifestations include voluntary and involuntary movements of the large muscle groups, including facial grimacing and carpopedal spasm. Blood pressure rises 20 to 40 mm (both systolic and diastolic), and the heart rate increases up to 160 beats per minute. Orgasm lasts from 3 to 25 seconds and is associated with a slight clouding of consciousness.

Phase IV: Resolution
Resolution consists of the disgorgement of blood from the genitalia (detumescence) which brings the body back to its resting state. If orgasm occurs, resolution is rapid and is characterized by a subjective sense of well-being, general relaxation, and muscular relaxation.
If orgasm does not occur, resolution may take from 2 to 6 hours and may be associated with irritability and discomfort. After orgasm, men have a refractory period that may last from several minutes to many hours; in that period they cannot be stimulated to further orgasm. Women do not have a refractory period and are capable of multiple and successive orgasms.

Masturbation is usually a normal precursor of object-related sexual behaviour. No other form of sexual activity has been more frequently discussed, more roundly condemned, and more universally practiced than masturbation. With the approach of puberty, the upsurge of sex hormones, and the development of secondary sex characteristics, there is an increase in sexual curiosity and masturbation. Adolescents are physically capable of coitus and orgasm, but are usually inhibited by social restraints. The dual and often conflicting pressures of establishing their sexual identities and controlling their sexual impulses produce a strong physiological sexual tension in teenagers that demands release, and masturbation is a normal way to reduce sexual tensions.

Moral taboos against masturbation have generated myths that masturbation causes mental illness or decreased sexual potency. No scientific evidence supports such claims. Masturbation is a psychopathological symptom only when it becomes a compulsion beyond a person’s willful control. Then, it is a symptom of emotional disturbance, not because it is sexual but because it is compulsive. Masturbation is probably a universal aspect of psychosexual development and, in most cases, it is adaptive.

There are many professionals trained to talk about sex and help people to explore and overcome sexual dysfunction. Psychosexual therapists in particular are very knowledgeable about a wide range of sex problems and have proven successful in helping individuals and couples of all ages, health and sexuality to realize their sexual needs and desires and work through any negative thoughts that may be affecting their ability to enjoy sex and sexual intimacy.

Psychosexual therapy may involve exploring family myths and cultural taboos that have impacted on the way someone associates with sex and sexual intimacy. Questions that may be asked are: “If sex was once enjoyable, what happened to change that?” and “What feels good and what feels disappointing?”. These encourage the re-examination of deep-set sexual assumptions and beliefs, and in a good therapeutic relationship between client and therapist, there will be the opportunity to find answers and develop a healthier relationship with sex and sexual intimacy. For example, generalized anxiety disorder, psychosis or depression may be the underlying cause. If there is a primary psychiatric problem, it is treated with psychotherapy and appropriate medications.

Sexual dysfunction caused by psychotropic medications has become an increasingly important clinical topic. Only recently have we acknowledged the extent to which many psychotropic medications, especially antidepressants and antipsychotics, cause sexual side effects. Prevalence rates of sexual side effects are extraordinarily difficult to estimate due to a variety of factors, such as the effect of the disorder being treated, comorbid disorders and baseline sexual dysfunction. Among the antidepressants, those with strong serotonergic properties have the highest rate of sexual side effects. Treatment approaches have been poorly developed for both antidepressants and antipsychotics. Antidotes for antidepressant-induced sexual dysfunction include bupropion, buspirone and sildenafil.

Arousal is triggered by both psychological and physical stimuli; levels of tension are experienced both physiologically and emotionally; and, with orgasm, normally a subjective perception of a peak of physical reaction and release occurs. Psychosexual development, psychological attitudes towards sexuality, and attitudes towards one’s sexual partner are directly involved with, and affect, the physiology of human sexual response. Every normal human being has four-phase sexual response cycle.

Phase I: Desire
The classification of the desire (or appetitive) phase, which is distinct from any phase identified solely through physiology, reflects the psychiatric concern with motivation towards sexual activity. This phase is characterized by sexual fantasies and the desire to have sexual activity.

Phase II: Excitement
The excitement and arousal phase, brought on by psychological stimulation (fantasy or the presence of a love object) or physiological stimulation (stroking or kissing) or a combination of the two, consists of a subjective sense of pleasure. During this phase, penile tumescence leads to erection in men and vaginal lubrication occurs in women. Various other changes occur in different parts of the body. Voluntary contractions of large muscle groups occur, heartbeat and respiration rates increase, and blood pressure rises. Heightened excitement lasts from 30 seconds to several minutes.

Phase III: Orgasm
The orgasm phase consists of a peaking of sexual pleasure, with the release of sexual tension and the rhythmic contraction of the perineal muscles and the pelvic reproductive organs.
A subjective sense of ejaculatory inevitability triggers men’s orgasms. The forceful emission of semen follows. The male orgasm is also associated with four to five rhythmic spasms of the prostate, seminal vesicles, vas, and urethra. In women, orgasm is characterized by 3 to 15 involuntary contractions of the lower third of the vagina and by strong sustained contractions of the uterus, flowing from the fundus downward to the cervix. Both men and women have involuntary contractions of the internal and external anal sphincters. Other manifestations include voluntary and involuntary movements of the large muscle groups, including facial grimacing and carpopedal spasm. Blood pressure rises 20 to 40 mm (both systolic and diastolic), and the heart rate increases up to 160 beats per minute. Orgasm lasts from 3 to 25 seconds and is associated with a slight clouding of consciousness.

Phase IV: Resolution
Resolution consists of the disgorgement of blood from the genitalia (detumescence) which brings the body back to its resting state. If orgasm occurs, resolution is rapid and is characterized by a subjective sense of well-being, general relaxation, and muscular relaxation.
If orgasm does not occur, resolution may take from 2 to 6 hours and may be associated with irritability and discomfort. After orgasm, men have a refractory period that may last from several minutes to many hours; in that period they cannot be stimulated to further orgasm. Women do not have a refractory period and are capable of multiple and successive orgasms.

For some men, being stressed may just make you irritable, but for others, too much stress can cause sexual problems, such as erectile dysfunction. For these men, learning to relax and ease stress is all that may be needed to treat ED.

1.Jacobson’s relaxation technique, also known as progressive relaxation therapy, is a type of therapy that focuses on tightening and relaxing specific muscle groups in sequence. By concentrating on specific areas and tensing and then relaxing them, you can become more aware of your body and physical sensations. General instructions for Jacobson’s technique involve tightening one muscle group while keeping the rest of the body relaxed, and then releasing the tension.

2.Rhythmic breathing: If your breathing is short and hurried, slow it down by taking long, slow breaths. Inhale slowly then exhale slowly. Count slowly to five as you inhale, and then count slowly to five as you exhale. As you exhale slowly, pay attention to how your body naturally relaxes. Recognizing this change will help you to relax even more.

3.Deep breathing: Imagine a spot just below your navel. Breathe into that spot, filling your abdomen with air. Let the air fill you from the abdomen up, then let it out, like deflating a balloon. With every long, slow exhalation, you should feel more relaxed.

4.Visualized breathing: Find a comfortable place where you can close your eyes and combine slowed breathing with your imagination. Picture relaxation entering your body and tension leaving your body. Breathe deeply, but in a natural rhythm. Visualize your breath coming into your nostrils, going into the lungs and expanding the chest and abdomen. Then, visualize your breath going out the same way. Continue breathing, but each time you inhale, imagine that you are breathing in more relaxation. Each time you exhale imagine that you are getting rid of a little more tension.

5.Progressive muscle relaxation: Switch your thoughts to yourself and your breathing. Take a few deep breaths, exhaling slowly. Mentally scan your body. Notice areas that feel tense or cramped. Quickly loosen up these areas. Let go of as much tension as you can. Rotate your head in a smooth, circular motion once or twice (Stop any movements that cause pain). Roll your shoulders forward and backward several times. Let all of your muscles completely relax. Recall a pleasant thought for a few seconds. Take another deep breath and exhale slowly. You should feel relaxed.

6.Relax to music: Combine relaxation exercises with your favorite music in the background. Select the type of music that lifts your mood or that you find soothing or calming. Some people find it easier to relax while listening to specially designed relaxation audio tapes, which provide music and relaxation instructions.

7.Mental imagery relaxation: Mental imagery relaxation, or guided imagery, is a proven form of focused relaxation that helps create harmony between the mind and body. Guided imagery coaches you in creating calm, peaceful images in your mind — a “mental escape.” Identify self-talk, that is, what you say to yourself about any problems you have. It is important to identify negative self-talk and develop healthy, positive self-talk. By making affirmations, you can counteract negative thoughts and emotions. Here are some positive statements you can practice.

Masters and Johnson have developed a modification of this procedure in which the wife manually stimulates the penis until it becomes erect. She then squeezes the penis at the coronal ridge for three to four seconds, which causes the man to lose the urge to ejaculate and to lose 10-30% of his erection. The wife waits fifteen to thirty seconds, then repeats the procedure. After practicing for a few days, the couple repeats the procedure with intra-vaginal containment of the penis, but no thrusting, to produce stimulation. The next steps are intra-vaginal containment with slow movement, and then fast movement, using the squeeze as before. Counseling and techniques advocated by Master and Jonson are used to help the patient perform sexual activity in a non-demanding manner.

The aim of Sensate Focus is to build trust and intimacy within your relationship, helping you to give and receive pleasure. It emphasizes positive emotions, physical feelings and responses while reducing any negative reactions. The program can help overcome any fear of failure that may have existed previously, building a more satisfying sexual relationship in which both partners feel able to ask for what they want and are able to give and receive pleasure. Continuous reinforcement is needed to overcome negative reactions to intimacy. How long you spend on the program is up to you. Typically, sessions last twenty to sixty minutes, two to three times a week, spread over six or more weeks

The aim of Sensate Focus is to build trust and intimacy within your relationship, helping you to give and receive pleasure. It emphasizes positive emotions, physical feelings and responses while reducing any negative reactions. The program can help overcome any fear of failure that may have existed previously, building a more satisfying sexual relationship in which both partners feel able to ask for what they want and are able to give and receive pleasure. Continuous reinforcement is needed to overcome negative reactions to intimacy. How long you spend on the program is up to you. Typically, sessions last twenty to sixty minutes, two to three times a week, spread over six or more weeks

Kegels are exercises you can do to strengthen your pelvic floor muscles – the muscles that support your urethra, bladder, uterus, and rectum. Strengthening your pelvic floor muscles may help prevent or treat urinary stress incontinence, a problem that affects up to 70 percent of women during or after pregnancy. Kegel exercises may also help reduce the risk of anal incontinence. Kegel’s improves circulation to your rectal and vaginal area, they may help keep hemorrhoids at bay and possibly speed healing after anepisiotomy or tear during childbirth. Finally, continuing to do Kegel exercises regularly after giving birth not only helps you maintain bladder control, it also improves the muscle tone of your vagina, making sex more enjoyable.

This method is based on exploring positive ways of viewing sex and sexuality to eliminate negative thoughts and attitudes about sex that interfere with sexual interest, pleasure, and performance. As positive sexual fantasies are associated with positive effects, general physiological arousal, and sexual arousal, cognitive behavior therapists encourage their use by asking the patient to deliberately identify arousing sexual fantasies.

Interpersonal psychotherapy is a short-term therapy lasting about 12 to 16 sessions, in which a client focuses on current interpersonal difficulties in their sexual life. Therapists using this approach focus on the connections between current life events and the onset and persistence of depressive symptoms. Specific problem areas in the patient’s life are identified, and the patient and therapist explore how they relate to the illness. By resolving interpersonal problems in their life, the patient improves their sexual life.

The efficiency of directed masturbation as an adjunct to the treatment of primary orgasmic dysfunction was evaluated. The directed masturbation procedure consists of a gradual series of assignments that are to be practiced by the patient. The test of the effectiveness of directed masturbation is conducted with couples who have not benefited from a sexual treatment program modeled after that of Masters and Johnson. The results have indicated that directed masturbation holds promise as an effective adjunct to sexual counseling.

Studies suggest a complex relationship between cognitive-behavioral therapy (CBT) and pharmacotherapy for the combined treatment of sexual disorders. Combined treatment should not be considered the default treatment for sexual disorders. Instead, decisions whether combined treatment is worth the added cost and effort should be made in relation to the disorder under treatment, the level of severity or chronicity, and the stage of treatment.

Pre-IVF and Pre-IUI counselling is essential to couples going for the IVF and IUI programme. Pre-IVF and Pre-IUI counselling can be done at our clinic prior to starting the programme. Psychological counselling is offered to all couples considering an IVF and IUI programme, as there are many important issues to be considered in the psychological welfare of the couple during what can be an extremely emotional and stressful time in their lives.

Post IUI and IVF grief counselling is given to patients with failed treatments. This is essential to maintain their confidence and restore hope for second opinion option

Supportive Psychotherapy is a form of psychotherapy that concentrates on creating an effective means of communication with an emotionally disturbed person rather than on trying to produce psychological insight into the underlying conflicts. Through such supportive measures as reassurance, reinforcement of the person’s defenses, direction, suggestion and persuasion, the therapist participates directly in the solution of specific problems.

Psychoeducation refers to the education offered to individuals with a mental health condition and their families to help empower them and deal with their condition in an optimal way. Sex therapy is a strategy for the treatment of sexual dysfunction when there is no medical etiology (physiological reason) or as a complement to medical treatment. The sexual dysfunctions which may be addressed by sex therapy include non-consummation, premature ejaculation, erectile dysfunction, low libido, unwanted sexual fetishes, sexual addiction, painful sex, or a lack of sexual confidence, assisting people who are recovering from sexual assault, problems commonly caused by stress, tiredness, and other environmental and relationship factors. Sex therapists assist those experiencing problems in overcoming them and in doing so, possibly help them in regaining an active sex life.

An addiction to masturbation and sex can be both physically and emotionally harmful to a person and their loved ones. Due to the amount of time and energy spent on masturbation and sex, genital injury is common. Additionally, an addiction to masturbation and sex can make intimate relationships difficult and hinder people from seeking out intimacy. Masturbation and sex addiction is a real problem regardless of morality. There are certainly many points of view regarding the morality or acceptability of masturbation. A professional sex therapist does not impose morality in the treatment of masturbation and sex addiction. It is the role of the therapist to honor a client’s personal morality while working with the client to reduce shame and explore healthy sexuality. For a masturbation and sex addict, a period of abstinence is recommended under the supervision of a trained therapist.

In addition to psychotherapy, pharmacotherapy is an important treatment option for paraphilias, especially in sexual offenders. Cyproterone Acetate (CPA) and Medroxyprogesterone Acetate (MPA) are commonly used but can have serious side effects. Selective Serotonin Reuptake Inhibitors (SSRIs) may also be effective in less severe cases. Recent research shows that Luteinizing Hormone-Releasing Hormone (LHRH) agonists may offer a new treatment option for treatment of paraphilic patients.

Study reveals that many substances like alcohol, cannabis etc. on a long term basis cause sexual dysfunction. There are effective therapies and both psychological and pharmacological interventions are helpful in achieving remission and attaining good sexual health. Drugs will be used for the treatment of this condition along with counselling. It has been found that only a very minute number of patients with this condition can be treated by using counselling alone. Therefore, psychotherapeutic techniques will always be used as an adjunct to medications during the treatment procedure.

Sildenafil is a nitric oxide enhancer that facilitates the inflow of blood to the penis necessary for an erection. The drug takes effect about 1 hour after ingestion, and its effect can last up to 4 hours. Sildenafil is not effective in the absence of sexual stimulation. The most common adverse events associated with its use are headaches, flushing, and dyspepsia. Sildenafil is not effective in all cases of erectile dysfunction. It fails to produce an erection rigid enough for penetration in about 50 percent of men.
Sildenafil use in women results in vaginal lubrication, but not in increased desire. Anecdotal reports, however, describe individual women who have experienced intensified excitement with sildenafil.

Tadalafil and udalafil are the drugs which act in aoral phentolamine and apomorphine are not US Food and Drug Administration (FDA) approved at present, but have proved effective as potency enhancers in men with minimal erectile dysfunction. Phentolamine reduces sympathetic tone and relaxes corporeal smooth muscle. Adverse events include hypotension, tachycardia, and dizziness. Apomorphine effects are mediated by the autonomic nervous system and result in vasodilatation that facilitates the inflow of blood to the penis. Adverse events include nausea and sweating.

Injectable and transurethral alprostadil act locally on the penis and can produce erections in the absence of sexual stimulation. Alprostadil contains a naturally occurring form of prostaglandin E, a vasodilating agent. Alprostadil may be administered by direct injection into the corpora cavernosa or by intraurethral insertion of a pellet through a canula. The firm erection produced within 2 to 3 minutes after administration of the drug may last as long as 1 hour. Infrequent and reversible adverse effects of injections include penile bruising and changes in liver function test results. Possible hazardous sequelae exist, including priapism and sclerosis of the small veins of the penis. Users of transurethral alprostadil sometimes complain of burning sensations in the penis.

Intravenous methohexital sodium has been used in desensitization therapy. Anti-anxiety agents may have some application in tense patients, although these drugs can also interfere with the sexual response. The side effects of antidepressants, in particular the SSRIs and tricyclic drugs, have been used to prolong the sexual response in patients with premature ejaculation.
Bromocriptine is used in the treatment of hyperprolactinemia, which is frequently associated with hypogonadism. Dopaminergic agents have been reported to increase libido and improve sex function. These drugs include L-dopa, a dopamine precursor, and bromocriptine, a dopamine agonist. The antidepressant bupropion has dopaminergic effects and has increased sex drive in some patients. Selegiline, an MAOI, is selective for MAOB and is dopaminergic. It improves sexual functioning in older persons.

Androgens increase the sex drive in women and in men with low testosterone concentrations. Women may experience virilizing effects, some of which are irreversible (e.g., deepening of the voice). In men, prolonged use of androgens produces hypertension and prostatic enlargement. Testosterone is most effective when given parenterally; however, effective oral and transdermal preparations are available.

Women who use estrogens for replacement therapy or for contraception may report decreased libido. In such cases, a combined preparation of estrogen and testosterone has been used effectively. Estrogen itself prevents thinning of the vaginal mucous membrane and facilitates lubrication. Two new forms of estrogen, vaginal rings and vaginal tablets, provide alternate administration routes to treat women with arousal problems or genital atrophy. Because tablets and rings do not significantly increase circulating estrogen levels, these devices may be considered for patients with breast cancer with arousal problems.

In male patients with arteriosclerosis (especially of the distal aorta, known as Leriche’s syndrome), the erection may be lost during active pelvic thrusting. The need for increased blood in the gluteal muscles and others served by the ilial or hypogastric arteries takes blood away (steals) from the pudendal artery and, thus, interferes with penile blood flow. Relief may be obtained by decreasing pelvic thrusting, which is also aided by the woman’s superior coital position.

Vacuum pumps are mechanical devices that patients without vascular disease can use to obtain erections. The blood drawn into the penis following the creation of the vacuum is kept there by a ring placed around the base of the penis. This device has no adverse effects, but it is cumbersome, and partners must be willing to accept its use. Some women complain that the penis is redder and cooler than when erection is produced by natural circumstances, and they find the process and the result objectionable.

Surgical treatment is infrequently advocated, but penile prosthetic devices are available for men with inadequate erectile responses who are resistant to other treatment methods or who have medically caused deficiencies. The two main types of prosthesis are (1) a semi-rigid rod prosthesis that produces a permanent erection that can be positioned close to the body for concealment and (2) an inflatable type that is implanted with its own reservoir and pump for inflation and deflation. The latter type is designed to mimic normal physiological functioning.

Sexuality is a central aspect of being human throughout life and encompasses sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy and reproduction. Sexuality is experienced and expressed in thoughts, fantasies, desires, beliefs, attitudes, values, behaviours, practices, roles and relationships. While sexuality can include all of these dimensions, not all of them are always experienced or expressed. Sexuality is influenced by the interaction of biological, psychological, social, economic, political, cultural, ethical, legal, historical, religious and spiritual factors.

Sexual health is a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled.

Sex therapy and sex counselling are two terms that really mean the same thing. Sex therapy is a specialized form of counselling for people which focuses on sexual issues, most often for individuals in relationships (although you do not need to be in a relationship to seek sex therapy).A sex therapist will try to help you develop a clearly defined issue and the goal of therapy will be to work on that issue and resolve it, or find a way to make whatever problems it causes have less of an impact on your life and sex life. Commonly sex therapy will focus on a sexual dysfunction or major sexual communication problems between partners. Sex therapy is usually directive. Sex therapists will be active, asking questions and often giving direct suggestions, homework exercises, and information in an effort to support your goals for the therapy.

The first step in sex therapy is evaluating and assessing the presenting problem or problems. A sexual history is taken which asks the patient to describe his/her sexual experiences. If it is a couple, each partner’s sexual history is taken. (Any information you give or conversation you have with your sex therapist will remain strictly confidential).The therapist carefully analyses the medical and historical data, together with any issues or related circumstances described by the you to identify all the strands that weave into the current condition. This evaluation results in a diagnosis and detailed treatment plan. The treatment will vary depending on the issue, but it usually involves special exercises for each individual or couple. Sex therapy is not “just talking.” Each week the therapist will suggest new experiences for the individual or couple to try in the privacy of their home. These at-home exercises are designed to take the pressure and worry out of sex. In subsequent sessions, the at-home exercises are discussed and any difficulties are explored. The exercises help the individual or couple “re-learn” more satisfying sexual behaviour. The therapist functions as a sex educator, providing accurate information about anatomy, physical response that is specific to the client’s sexual concern. The clients may be suggested books to read or educational videos to watch.

People of all ages, sexual orientations, genders, religions, and ethnicities may choose to seek the help of sex therapists. Sex therapy is appropriate for:
1. Individuals wanting to deal with sexual identity issues.
2.Couples wanting to increase sexual intimacy
3.People who want to deal with sexual inhibitions
4.People who are dissatisfied with their sexual functioning
5.Couples wanting to increase their communication about sexuality
There is no one “type” of person who goes to sex therapy and there are many more reasons to see a sex therapist than those mentioned above.

Generally a sex therapist should be chosen over a general psychotherapist, psychologist, psychiatrist, or other helping professional, when the issues are very specifically sex related, or when sexuality seems like a central part of the issue. Some examples of issues that bring people to sex therapy are:
1.Sexual trauma
2.Lack of orgasm
3.Difficulties with erections or ejaculation
4.Problems with differing levels of desire in a couple
5.Difficulties resulting from infidelities
6.Sexual concerns as a result of illness or surgery
This list is not exhaustive, and if you think you are interested in talking with a sex therapist, most will spend at least a short time on the phone with you to determine whether or not they are the appropriate person to be meeting with.

There is no one way of knowing when to seek professional help or support for sexual problems. The right time to do that is whenever it is right for you. If you are single and feel there are specific sexual concerns or issues that you can’t figure out on your own or work through with the support of friends or family, then trying to work with a sex therapist can be a helpful new way to approach the issues. Additionally people find the confidentiality offered by a sex therapist a more comfortable environment to approach these issues. If you are in a relationship the decision about when to see a sex therapist might be a bit more complicated. Does your partner also feel that seeing a sex therapist is a positive step in resolving sexual issues or concerns? Are you planning on going together, or are you interested in going on your own? An ethical sex therapist will suggest having an initial consultation, and if they feel that sex therapy isn’t going to be helpful they will, or should, let you know. Sex therapy isn’t necessarily for crisis management (although it might do that as well) and even if there are parts of your sexual relationship you are happy with, if you feel that you could benefit from some support, education, information, or counselling from a professional who is trained in the area of human sexuality, then exploring sex therapy as an option is perfectly reasonable.

If a couple is interested in sex therapy they will probably have to go to therapy together. But if you are the one interested in therapy, and you would prefer to have an initial session on your own, there is nothing wrong with starting the process this way. Depending on where the therapy goes, you may or may not bring in your partner at a later time.

We don’t share information from or about you, unless we think that someone is at risk of serious harm. In this instance, we would seek to discuss it with you first.